A Personalized Medicine Approach to the Management of IBD
A Personalized Medicine Approach to the Management of IBD
The medical management of inflammatory bowel disease (IBD) is evolving toward a personalized medicine-based model. Modern therapeutic algorithms that feature use of tumor necrosis factor (TNF) antagonists in combination with immunosuppressive are highly effective when initiated in high-risk patients early in the course of disease. Defined targets that guide intensification of therapy are critical interventions. In this model, therapy is optimized through appropriate pretreatment testing, therapeutic drug monitoring, and patient-based monitoring strategies. This review discusses the current application of personalized medicine to the management of IBD.
Over the past decade, the concept of personalized medicine has evolved from the framework of "the right drug, the right dose, in the right patient, at the right time, using the right route" to a standard of care for the management of chronic diseases. Personalized medicine has potential to optimize efficacy, decrease the risk of adverse events, and minimize costs through the integration of genetic and conventional laboratory testing, as well as clinical variables such as age, gender, and relevant renal and hepatic function to guide treatment decisions.
As part of this paradigm, modern therapeutic algorithms have evolved for the management of inflammatory bowel disease (IBD) that feature use of tumor necrosis factor (TNF) antagonists in combination with immunosuppressives (azathioprine (AZA), 6-mercaptopurine (6-MP), and methotrexate) early in the course of the disease in high-risk patients. The goal of this strategy is to avoid long-term complications, disability, and mortality by preventing permanent bowel damage. Defined targets are used to guide treatment intensification with mucosal healing as a primary goal. Therapeutic drug monitoring (TDM) is an essential component of personalized medicine wherein serum drug concentrations or their metabolic by-products are measured and utilized to adjust dosing. Emerging evidence indicates that patients have a vital role in this model through active participation in monitoring disease activity. This review discusses the strategies currently available for selecting and monitoring IBD therapy and speculates on the future role of personalized medicine in disease management.
Abstract and Introduction
Abstract
The medical management of inflammatory bowel disease (IBD) is evolving toward a personalized medicine-based model. Modern therapeutic algorithms that feature use of tumor necrosis factor (TNF) antagonists in combination with immunosuppressive are highly effective when initiated in high-risk patients early in the course of disease. Defined targets that guide intensification of therapy are critical interventions. In this model, therapy is optimized through appropriate pretreatment testing, therapeutic drug monitoring, and patient-based monitoring strategies. This review discusses the current application of personalized medicine to the management of IBD.
Introduction
Over the past decade, the concept of personalized medicine has evolved from the framework of "the right drug, the right dose, in the right patient, at the right time, using the right route" to a standard of care for the management of chronic diseases. Personalized medicine has potential to optimize efficacy, decrease the risk of adverse events, and minimize costs through the integration of genetic and conventional laboratory testing, as well as clinical variables such as age, gender, and relevant renal and hepatic function to guide treatment decisions.
As part of this paradigm, modern therapeutic algorithms have evolved for the management of inflammatory bowel disease (IBD) that feature use of tumor necrosis factor (TNF) antagonists in combination with immunosuppressives (azathioprine (AZA), 6-mercaptopurine (6-MP), and methotrexate) early in the course of the disease in high-risk patients. The goal of this strategy is to avoid long-term complications, disability, and mortality by preventing permanent bowel damage. Defined targets are used to guide treatment intensification with mucosal healing as a primary goal. Therapeutic drug monitoring (TDM) is an essential component of personalized medicine wherein serum drug concentrations or their metabolic by-products are measured and utilized to adjust dosing. Emerging evidence indicates that patients have a vital role in this model through active participation in monitoring disease activity. This review discusses the strategies currently available for selecting and monitoring IBD therapy and speculates on the future role of personalized medicine in disease management.
